Let us consider the following clinical vignette:
A 61 y/o male presents complaining of migraines on the order of 2 or 3 times a month. When he gets them, the only thing that helps to mitigate them is a combination of Sumatriptan 100mg and Tramadol 37.5/325 . Given the patient's background, He asks you "I was hoping to commence treatment with an SNRI like Effexor or Cymbalta but I am concerned about Serotonin Syndrome when I get a migraine."
Based on best practice and current evidence, how legitimate are the patient's concerns?